Organization
MEDICAL VITALITY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA ANSON (DELEGATED OFFICAL)
(305) 279-2276
Entity
Organization
Contact information
Practice address
1845 CORDOVA RD STE 204, FORT LAUDERDALE, FL 33316-6100
(954) 361-3343
Mailing address
1845 CORDOVA RD STE 204, FORT LAUDERDALE, FL 33316-6100
(954) 361-3343
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
12/20/2019
Last updated
12/20/2019
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